Drug interactions
Clozapine + Nalbuphine
Severity: Major
Clozapine and Nalbuphine: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Clozapine is highly sedating and can cause orthostatic hypotension and, rarely, circulatory and respiratory collapse, especially when started or combined with other CNS depressants. Adding nalbuphine may intensify sedation and respiratory depression.
What this interaction means in plain words
Clozapine and Nalbuphine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Clozapine belongs to Central Nervous System; Nalbuphine belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression, with clozapine's antagonism at histamine, alpha-adrenergic and other receptors adding hypotension.
What to do
Use the lowest effective nalbuphine dose and monitor sedation, blood pressure and respiration, especially during clozapine initiation or titration. Reduce doses if excessive sedation occurs.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
Other interactions of Clozapine
- Clozapine + Deferiprone Contraindicated
- Clozapine + Irinotecan Contraindicated
- Clozapine + Pimozide Contraindicated
- Clozapine + Thioridazine Contraindicated
- Acalabrutinib + Clozapine Major
- Adagrasib + Clozapine Major
Frequently asked questions
Can I take Clozapine with Nalbuphine?
MediHelp rates the interaction as major. Clozapine and Nalbuphine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Clozapine is highly sedating and can cause orthostatic hypotension and, rarely, circulatory and respiratory collapse, especially when started or combined with other CNS depressants. Adding nalbuphine may intensify sedation and respiratory depression.
How serious is the interaction between Clozapine and Nalbuphine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective nalbuphine dose and monitor sedation, blood pressure and respiration, especially during clozapine initiation or titration. Reduce doses if excessive sedation occurs.
What other medicines interact with Nalbuphine?
MediHelp also lists interactions of Nalbuphine with, for example, Alvimopan, Olanzapine / samidorphan, Alprazolam. The full list is on the Nalbuphine page.
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